Diagnosis Of Peripheral Lesions Research Articles

Cone-Beam CT Image Guidance With and Without Electromagnetic Navigation Bronchoscopy for Biopsy of Peripheral Pulmonary Lesions.

Background:Bronchoscopic diagnosis of small peripheral lung lesions suspected of lung cancer remains a challenge. A successful endobronchial diagnosis comprises navigation, confirmation, and tissue acquisition. In all steps, 3-dimensional information is essential. Cone-beam computed tomography (CBCT) imaging can provide computed tomography information and 3-dimensional augmented fluoroscopy imaging. We assessed whether CBCT imaging can improve navigation and diagnosis of peripheral lesions by 2 clinical workflows with a cross-over design: (1) a primary CBCT and radial endobronchial ultrasound mini probe imaging–based approach and (2) a primary electromagnetic navigation (EMN) and radial endobronchial ultrasound mini probe imaging–based approach.Methods:All patients with a peripheral lung lesion biopsy indication were eligible for study inclusion and randomly assigned to study arms. Commercially available equipment was used. The main study goals were to assess CBCT-confirmed navigation success and diagnostic accuracy. Surgery or unambiguous clinical follow-up served as the gold standard.Results:Eighty-seven patients with 107 lesions were included. Lesion mean longest axis size in the CBCT arm was 16.6 mm (n=47) and 14.2 mm in the EMN arm (n=40). The primary CBCT approach and primary EMN approach had 76.3% and 52.2% navigation success, respectively. Addition of EMN to the CBCT approach increased navigation success to 89.9%. Addition of CBCT imaging to the EMN approach significantly increased navigation success to 87.5% per lesion. The overall diagnostic accuracy per patient was significantly lower than the navigation success, being 72.4%.Conclusion:CBCT imaging is a valuable addition to navigation bronchoscopy. Although overall navigation success was high, the diagnostic accuracy remains to be improved. Future research should focus on improving the tissue acquisition methodology.

Advanced bronchoscopic techniques in diagnosis and staging of lung cancer.

The role of advanced brochoscopic diagnostic techniques in detection and staging of lung cancer has steeply increased in recent years. Bronchoscopic imaging techniques became widely available and easy to use. Technical improvement led to merging in technologies making autofluorescence or narrow band imaging incorporated into one bronchoscope. New tools, such as autofluorescence imagining (AFI), narrow band imaging (NBI) or fuji intelligent chromo endoscopy (FICE), found their place in respiratory endoscopy suites. Development of endobronchial ultrasound (EBUS) improved minimally invasive mediastinal staging and diagnosis of peripheral lung lesions. Linear EBUS proven to be complementary to mediastinoscopy. This technique is now available in almost all high volume centers performing bronchoscopy. Radial EBUS with mini-probes and guiding sheaths provides accurate diagnosis of peripheral pulmonary lesions. Combining EBUS guided procedures with rapid on site cytology (ROSE) increases diagnostic yield even more. Electromagnetic navigation technology (EMN) is also widely used for diagnosis of peripheral lesions. Future development will certainly lead to new improvements in technology and creation of new sophisticated tools for research in respiratory endoscopy. Broncho-microscopy, alveoloscopy, optical coherence tomography are some of the new research techniques emerging for rapid technological development.

Endoscopy: a clinical state of the art

Endoscopy has been used for a long time in pulmonary diseases departments all over the world, but in recent years a lot of new ideas have become available regarding the role of thoracoscopy for the pulmonologist, not only for diagnosis but also concerning treatment. Furthermore, new diagnostic bronchoscopy techniques are now in use, which are especially interesting in the staging of mediastinal lymph nodes and further diagnosis of peripheral lesions in the lung. The purpose of the international symposium “Endoscopy: a clinical state of …

Electromagnetic navigation in lung cancer: research update

Unfortunately, flexible bronchoscopy, the least invasive bronchoscopic procedure, is of limited value for obtaining tissue from lesions in the peripheral segments of the lung. Biopsy success is further compromised if the lesion is less than 3 cm in diameter. The main limitation of flexible bronchoscopy is the difficulty in reaching peripheral lesions with the accessory tools. In this paper, we will discuss a new bronchoscopic advance in the diagnosis and treatment of lung cancer. Once extended beyond the tip of the bronchoscope, these tools are difficult to guide to the desired location. Localizing the lesion under fluoroscopy is difficult, and alternative diagnostic guidance methods, such as computer tomography-guided bronchoscopy and endobronchial ultrasound, are more demanding. Therefore, new methods for navigation and localization are needed. One of these new technologies is electromagnetic navigation bronchoscopy. The aim of this special report is to provide an analysis of the published literature. A literature search was constructed and performed on PubMed to identify the literature from 2000 to 2008. The search words were ‘electromagnetic navigation’, ‘coin lesion’, ‘solitary pulmonary nodule’ and ‘lung cancer’. We review a number of recent studies that utilize electromagnetic navigation and guidance, and analyze their performance characteristics for clinical applications of the technology. Electromagnetic navigation is likely to play an increasing and integral role in the diagnosis and staging of lung cancer in the near future. Electromagnetic registration may impact both the staging and diagnosis of peripheral lesions.

Advances in bronchoscopic diagnosis of lung cancer

In this chapter we will discuss two bronchoscopic advances in the diagnosis and staging of lung cancer. Endobronchial ultrasound utilizes a flexible ultrasound probe fed through the working channel of a bronchoscope to image and biopsy lesions and lymph nodes beyond the wall of the bronchus. Electromagnetic navigation and guidance involves a specialized electromagnetic table with a computer program that maps the endobronchial tree and then helps navigate a bronchoscope to a particular lesion or lymph node. We review a number of recent studies that utilize endobronchial ultrasound and electromagnetic navigation and guidance and analyze their performance characteristics for lung cancer diagnosis and staging as well the clinical applications of both technologies. Both are likely to play an increasing and integral role in the diagnosis and staging of lung cancer in the near future. Endobronchial ultrasound will likely have its greatest impact on mediastinal lymph node staging while electromagnetic registration may impact both staging and diagnosis of peripheral lesions.

Electronystagmography: how helpful is it?

Two hundred and sixty patients tested with electronystagmography (ENG) for evaluation of complaints of disequilibrium were the representative sample for this study. As all new dizzy patients currently receive an ENG, the goal of this project was to determine how much an ENG adds to the diagnostic acumen, and which patients really needed an ENG in order to maximize efficiency and minimize patient cost. Results indicate the suspected diagnosis prior to ENG is assisted by its use only when the cause is thought to be central or is uncertain. The percentage of unknown causes of disequilibrium decreased from 34.2 to 13.8 per cent and the percentage of central causes increased from 13.1 to 23.1 per cent. Electronystagmography does not significantly aid in the diagnosis of peripheral lesions except as confirmation. Specific findings and recommendations are discussed.

Book reviewsNeedle Biopsy and Transbronchial Biopsy With Special Reference to Carcinoma of the Lung. Ed by SinnerW. N., pp. 132 + index, 1982 (Thieme, Stuttgart). DM 148 ISBN 313–6206–010

Although needle biopsy has been known for many years, there has been some reluctance to use it in peripheral lung lesions because of the possibilities of complications—bleeding and spread along the needle track—and the belief that the amount of tissue obtained is inadequate for histological diagnosis. There have been many reports of the results of needle biopsy of the lung, demonstrating that this is a very useful technique in the diagnosis of peripheral lesions.